Ji Shaozhen, Sun Hong, Jin Xianglan, Chen Baoxin, Zhou Jing, Zhao Jiayi, Liang Xiao, Shen Wei, Zhang Yunling, Chan Piu
Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China.
Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China.
Front Neurol. 2022 Sep 27;13:977641. doi: 10.3389/fneur.2022.977641. eCollection 2022.
The objective cognitive trajectory in patients with post-stroke subjective cognitive complaints (SCC) over time remained unknown. We investigated cognitive outcomes in patients with SCC within 1 year after stroke, and determined factors associated with cognitive recovery.
This study included 599 patients with a clinical diagnosis of post-stroke SCC and evidence of cognitive deficits including Clinical Dementia Rating Scale (CDR) = 0.5, Montreal Cognitive Assessment (MoCA) score <26, and Mini-Mental State Examination score >17 (illiterate) or >20 (primary school) or >24 (junior school or above). Neuropsychological assessment was performed at baseline (2 weeks to 6 months after stroke) and 6-month follow-up visit. Cognitive recovery was operationalized as unimpaired cognition (MoCA score ≥26 and CDR = 0) after 6 months. Factors associated with recovery were defined through logistic regression analysis.
After 6 months, 583 patients completed the follow-up with 80 (13.72%) presenting cognitive recovery, among which, 22 (9.48%) cases reported SCC within 2 weeks after stroke, six (10%) at 15-30 days, 13 (15.12%) at 31-60 days, 10 (16.13%) at 61-90 days, five (10.42%) at 91-120 days, nine (23.08%) at 121-150 days, and 15 (26.79%) at 151-180 days. Compared to those reported cognitive complaints at 151-180 days after stroke, patients with early post-stroke SCC had poorer cognitive recovery, which was only significant in individuals with high level of education. Male sex, higher baseline MoCA scores, coffee intake and thalamus lesions were independently associated with high chance of cognitive recovery.
Although post-stroke SCC contributes to persisting objective cognitive deficits, some patients presented cognitive recovery within 1 year after stroke. Patients with a high education level reporting SCC at earlier stage after stroke had poorer cognitive recovery. Male, higher baseline MoCA scores, coffee intake and thalamus lesions appear to independently predict cognitive recovery.
卒中后主观认知障碍（SCC）患者的客观认知轨迹随时间的变化仍不明确。我们调查了卒中后1年内SCC患者的认知结局，并确定了与认知恢复相关的因素。
本研究纳入599例临床诊断为卒中后SCC且有认知缺陷证据的患者，包括临床痴呆评定量表（CDR）=0.5、蒙特利尔认知评估量表（MoCA）评分<26以及简易精神状态检查表评分>17（文盲）或>20（小学）或>24（初中及以上）。在基线（卒中后2周~6个月）和6个月随访时进行神经心理学评估。认知恢复定义为6个月后认知功能未受损（MoCA评分≥26且CDR = 0）。通过逻辑回归分析确定与恢复相关的因素。
6个月后，583例患者完成随访，其中80例（13.72%）出现认知恢复，其中，22例（9.48%）在卒中后2周内出现SCC，6例（10%）在1530天出现，13例（15.12%）在3160天出现，10例（16.13%）在6190天出现，5例（10.42%）在91120天出现，9例（23.08%）在121150天出现，15例（26.79%）在151180天出现。与卒中后151~180天出现认知障碍的患者相比，卒中后早期SCC患者的认知恢复较差，这仅在高学历个体中显著。男性、较高的基线MoCA评分、咖啡摄入量和丘脑病变与认知恢复的高可能性独立相关。
尽管卒中后SCC会导致持续存在的客观认知缺陷，但部分患者在卒中后1年内出现了认知恢复。卒中后早期出现SCC的高学历患者认知恢复较差。男性、较高的基线MoCA评分、咖啡摄入量和丘脑病变似乎可独立预测认知恢复。
